<{include file="header.html"}>
<{include file="top.html"}>
<div class="h_980 clearfix"> 
            <div class="FosfMain">
                <div id="login_default">
                    	<h1><{T w='My Account Information'}></h1>
                        <h4><{T w='NOTE:'}><{T w='CreateTIP'}></h4>
                        <h5><{T w='* Required information'}></h5>
                        <h5 class="ld_item"><{T w='Address Details'}></h5>
                        <script type="text/javascript">
                        $(function(){
                        $(".registerform:last").Validform({
                        		tiptype:2,
                        		ajaxPost:true,
                        		callback:function(data){
                        			if(data.status=='y'){
                        				setTimeout(function(){
                        					$.Hidemsg();
                                            location.href="<{spUrl c=main a=CreateAccountSuccess}>";
                        				},2000);
                        			}
                        		} 
                        	});
                        });
                        </script>
    
                     <form class="registerform" action="<{spUrl c=main a=CreateAccount}>">
                        <input type="hidden" name="action" value="process" /><input type="hidden" name="email_pref_html" value="email_format" /> 
                        <table width="100%" class="maxtb">
                        	<tr>
                            	<td width="150"><label for="firstname" ><{T w='First name'}>:</label></td>
                                <td width="280">
                                    <input type="text" id="firstname" maxlength="32" size="33" name="firstname" class="Fosfinput" datatype="*2-30" errormsg="<{T w='Is your first name correct? Our system requires a minimum of 2 characters. Please try again.'}>" nullmsg="<{T w='Is your first name correct? Our system requires a minimum of 2 characters. Please try again.'}>"/>
                                </td><td><span class="alert Validform_checktip">*</span></td>
                            </tr>
                            <tr>
                            	<td><label for="lastname" ><{T w='Last name'}>:</label></td>
                                <td>
                                    <input type="text" id="lastname" maxlength="32" size="33" name="lastname" class="Fosfinput" datatype="*2-30" errormsg="<{T w='Is your last name correct? Our system requires a minimum of 2 characters. Please try again.'}>" nullmsg="<{T w='Is your last name correct? Our system requires a minimum of 2 characters. Please try again.'}>"/>
                                    </td><td><span class="alert Validform_checktip">*</span></td>
                            </tr>
                            <tr>
                            	<td><label for="street-address" ><{T w='Street address'}>:</label></td>
                                <td>
                                    <input type="text" id="street-address" maxlength="64" size="41" name="street_address" class="Fosfinput" datatype="*5-30" errormsg="<{T w='Your Street Address must contain a minimum of 5 characters.'}>" nullmsg="<{T w='Your Street Address must contain a minimum of 5 characters.'}>"/>
                                    </td><td><span class="alert Validform_checktip">*</span></td>
                            </tr>
                            <tr>
                            	<td><label for="suburb" ><{T w='Address Line 2'}>:</label></td>
                                <td>
                                    <input type="text" id="suburb" maxlength="32" size="33" name="suburb" class="Fosfinput"/>
                                </td>
                            </tr>
                            <tr>
                            	<td><label for="city" ><{T w='City'}>:</label></td>
                                <td>
                                    <input type="text" id="city" maxlength="32" size="33" name="city" class="Fosfinput" datatype="*2-20" errormsg="<{T w='Your City must contain a minimum of 2 characters.'}>" nullmsg="<{T w='Your City must contain a minimum of 2 characters.'}>"/>
                                    </td><td><span class="alert Validform_checktip">*</span></td>
                            </tr>
                            <tr>
                            	<td><label id="stateLabel" for="state" ><{T w='State/Province'}>:</label></td>
                                <td>
                                    <input type="text" id="state" maxlength="32" size="33" value="" name="state" class="Fosfinput" datatype="*2-20" errormsg="<{T w='Your State/Province must contain a minimum of 2 characters'}>" nullmsg="<{T w='Your State/Province must contain a minimum of 2 characters'}>"/>&nbsp;
    
                                    </td><td><span class="alert Validform_checktip">*</span></td>
                            </tr>
                            <tr>
                            	<td><label for="postcode" ><{T w='Post/Zip Code'}>:</label></td>
                                <td>
                                    <input type="text" id="postcode" maxlength="10" size="11" name="postcode" class="Fosfinput" datatype="*4-20" errormsg="<{T w='Your Post/ZIP Code must contain a minimum of 4 characters.'}>" nullmsg="<{T w='Your Post/ZIP Code must contain a minimum of 4 characters.'}>"/>
                                    </td><td><span class="alert Validform_checktip">*</span></td>
                            </tr>
                            <tr>
                            	<td><label for="country" ><{T w='Country'}>:</label></td>
                                <td>
                                     <select name="zone_country_id" id="country" datatype="select" errormsg="<{T w='You must select a country from the Countries pull down menu.'}>">
                                      <option value=""><{T w='Please Choose Your Country'}></option>
                                      <{foreach item=item key=key from=$countries}>
                                      <option value="<{$item.countries_id}>"><{$item.countries_name}></option>
                                      <{/foreach}>
                                    </select>
                                    </td><td><span class="alert Validform_checktip">*</span></td>
                            </tr>
                            <tr>
                            	<td><label  for="telephone"><{T w='Telephone'}>:</label></td>
                                <td>
                                    <input id="telephone" type="text" maxlength="32" size="33" name="telephone" class="Fosfinput" datatype="*3-20" nullmsg="<{T w='Your Telephone Number must contain a minimum of 3 characters.'}>" errormsg="<{T w='Your Telephone Number must contain a minimum of 3 characters.'}>"/>
                                    </td><td><span class="alert Validform_checktip">*Required For Shipping.</span></td>
                            </tr>
                        </table>
                        
                        <h5 class="ld_item"><{T w='Login Details'}></h5>
                        <table width="100%" class="maxtb">
                        	<tr>
                            	<td width="150"><label  for="email-address"><{T w='Email Address'}>:</label></td>
                                <td width="280">
                                   	<input id="email-address" type="text" maxlength="96" size="41" name="email_address" class="Fosfinput" ajaxurl="<{spUrl c=main a=checkemail}>" datatype="e" errormsg="<{T w='Is your email address correct? It should contain at least 6 characters. Please try again.'}>" nullmsg="<{T w='Is your email address correct? It should contain at least 6 characters. Please try again.'}>"/>
                                    </td><td><span class="alert Validform_checktip">*</span></td>
                            </tr>
                            <tr>
                            	<td><label  for="password-new"><{T w='Password'}>:</label></td>
                                <td>
                                    <input id="password-new" type="password" maxlength="40" size="21" name="password" class="Fosfinput" datatype="*1-30" nullmsg="<{T w='Your Password must contain a minimum of 1 characters.'}>" errormsg="<{T w='Your Password must contain a minimum of 1 characters.'}>"/>
                                    </td><td><span class="alert Validform_checktip">*</span></td>
                            </tr>
                            <tr>
                            	<td><label  for="password-confirm"><{T w='Confirm password'}>:</label></td>
                                <td>
                                    <input id="password-confirm" type="password" maxlength="40" size="21" name="confirmation" class="Fosfinput" datatype="*" recheck="password" nullmsg="<{T w='The Password Confirmation must match your new Password.'}>" errormsg="<{T w='The Password Confirmation must match your new Password.'}>"/>
                                    </td><td><span class="alert Validform_checktip">*</span></td>
                            </tr>
                        </table>
                        
                        <div class="a_right">
                        <input type="image" title=" <{T w='Submit the Information'}> " alt="<{T w='Submit the Information'}>" src="<{$smarty.const.BASEPATH}>/css/img/button_submit.gif">
                   	    </div>
                </form>
            
                    <!--login template end-->
                </div>
                </div>    
                   
                    
            <!--login template end-->

</div>  
<{include file="footer.html"}>
</body>
</html>